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Nationwide rates for HCPCS 99253

Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.

Facilitymedian $123 · 10th–90th $81$2630%20%40%10th90th$123Professionalmedian $129 · 10th–90th $81$2880%20%40%10th90th$129$0.0$0.2$2.0$20.0$200.0$2.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $112.20 / $181.97
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $128.82 / $288.40
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $120.23 / $302.00
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $123.03 / $223.87
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $144.54 / $154.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $144.54 / $245.47
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $100.00 / $134.90
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $134.90 / $263.03